Feasibility and efficacy of high-speed gait training with a voluntary driven exoskeleton robot for gait and balance dysfunction in patients with chronic stroke

Abstract

The aim of this pilot study was to investigate the feasibility of high-speed gait training with an exoskeleton robot hybrid assistive limb (HAL) in patients with chronic stroke, and to examine the efficacy of eight sessions (8 weeks) of gait training with a HAL compared with conventional physical therapy. Eighteen patients with chronic stroke were included in this study (nine each in the HAL and control groups). The HAL group underwent high-speed gait training with the HAL once a week for 8 weeks (20 min/session). The control group underwent conventional physical therapy for gait disturbance. Outcome measures were walking speed, number of steps, and cadence during a 10 m walking test, a timed up and go test, a functional reach test, and the Berg Balance Scale. Assessments were performed in the absence of the HAL before training and after the fourth and eighth training sessions. All patients in the HAL group completed the high-speed gait training without adverse events. The HAL group improved significantly in walking speed (55.9% increase, P<0.001), number of steps (17.6% decrease, P<0.01), and cadence (32.8% increase, P<0.001) during the 10 m walking test. The patients also exhibited significant improvements in the timed up and go test, the functional reach test, and the Berg Balance Scale after HAL training (P<0.01 in all). No statistical time-dependent changes were observed in any parameter in the control group. For chronic stroke patients, high-speed gait training with a HAL appears to be feasible and effective in improving gait and balance dysfunction despite the limitations of this nonrandomized pilot study.

Sustained effects of once-a-week gait training with hybrid assistive limb for rehabilitation in chronic stroke: case study

“…The results indicated that continuous gait training with HAL, in addition to conventional physical therapy, improved walking speed and balance function in a subject with chronic stroke, similar to the finding in our previous study15 ) that evaluated the effectiveness of HAL training for chronic stroke patients in comparison with control group. The improvements in gait and balance function in the present case were mostly maintained at least for two months after the gait training while the walking speed gradually tended to decrease slightly.…”

Effects of Exoskeleton Gait Training on Balance, Load Distribution, and Functional Status in Stroke: A Randomized Controlled Trial

“…The study by Yoshimoto et al (30) showed significant improvement in the Timed Up and Go test in chronic stroke patients and in the functional reach test and the Berg Balance Scale after training in the HAL exoskeleton (once a week for 8 weeks, 20 min per session). The control group underwent conventional physical therapy for gait disturbances, but significant differences in balance were not observed (30). Also, the research of Hornby et al (13) or Hidler et al (31), comparing the effects of conventional rehabilitation with treatment on the Lokomat robot, did not show any significant differences in balance assessed by the Berg Balance Scale (13,31).…”

“…In the available literature, there are no studies which assess changes in balance among patients rehabilitated using an exoskeleton. Most authors have reported various aspects of gait (11,13,28,30), and only a few papers present some data about changes in the balance, but only based on subjective scales as the Berg Balance Scale (13,14). There are no studies in which changes in balance due to rehabilitation with the exoskeleton were examined using an objective tool such as a stabilometric platform.…”

Self-perceived functioning and disability after randomized conventional and electromechanically-assisted gait training in subacute stroke: A 6 months follow-up

“…At present, several studies have explored the use of HAL for gait training in different stages after stroke [77][78][79][80][81][82][84][85][86][87][88][89][90][91][92][93][94][95][96][97][98][99][100][101]. The studies differ in terms of aim, design, duration of intervention, diagnosis, setting, and patient characteristics as well as allocation, randomization, blinding and outcome measures.…”